Provider Demographics
NPI:1538281217
Name:HANDICAP VILLAGE
Entity Type:Organization
Organization Name:HANDICAP VILLAGE
Other - Org Name:OPPORTUNITY VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-355-1200
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-0622
Mailing Address - Country:US
Mailing Address - Phone:641-357-5277
Mailing Address - Fax:641-357-6491
Practice Address - Street 1:1200 N 9TH ST W
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-1100
Practice Address - Country:US
Practice Address - Phone:641-357-5277
Practice Address - Fax:641-357-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0742445Medicaid